Bu retrospektif çalýþmada biyopsi yapýlan çocuklarda prosedürel sedasyon için intravenöz ketamin-propofol kombinasyonun (ketofol) etkinliðini ve güvenilirliðini deðerlendirmek amaçlanmýþtýr. Hasta kayýtlarýndan yaþ, cinsiyet, taný, iþlem süresi, total ketofol dozu, derlenme zamaný, total sedasyon zamaný, ve yan etki verileri toplandý. Toplam 6 aylýk süre içinde biyopsi sýrasýnda sedasyon için 80 hastada (40 kadýn ve 40 erkek) ketofol kullanýldýðý görüldü. Bu hastalarýn ortalama yaþý 7.4 ± 4.6 yýl, ortalama iþlem süresi 14 ± 3.6dakika idi. Ortalama kilolarý 28.4 ± 15.5 kg, ortalama indüksiyon dozu ise 2 ± 1.17 mg/kg idi. Hastalar ortalama 13.9 ± 5.8 dakikada derlendi. Total sedasyon zamanlarý ortalama 28.3 ± 8.1 dakika idi. Yan etki 28 hastada (%35) gözlendi. Bu hastalarýn 20’sinde nistagmus (%25), 4’ünde geçici diplopi (%5), 4’ünde (%5) ajitasyon saptandý. Hiçbir hastada havayolu müdahalesi gerekmedi; hipotansiyon, kusma olmadý. Biz bu çalýþmada ketofolün biyopsi sýrasýnda tüm hastalarda yeterli sedasyon ve hareketsizlik saðladýðýný, hiçbir ciddi komplikasyon olmadan, hemodinamik stabilite ve tatmin edici derlenme saðladýðýný gözlemledik. Verilerimiz biyopsi yapýlan çocuklarda ketofolün etkin ve güvenli sedasyon yaptýðýný göstermektedir.

The aim of this study was to evaluate the effectiveness and safety of an intravenous ketamine-propofol combination (ketofol) for procedural sedation in children undergoing biopsies. In this retrospective study, the data collected from patients’ records included: age, sex, weight, diagnosis, procedure length, time to sedation, total ketofol dose, recovery time, total sedation time, and adverse effects. A total of 80 patients (40 females and 40 males) received ketofol for sedation for biopsies over a 6-month period. The average age of the patients was 7.4 ± 4.6 years. The average length of the procedures was 14 ± 3.6 minutes. The average weight of the patients and the average induction dose were 28.4 ± 15.5 kg and 2 ± 1.17 mg/kg, respectively. Patients recovered in an average time of 13.9 ± 5.8 minutes and the average sedation time was 28.3 ± 8.1 minutes. A total of 28 patients (35%) had adverse events, including 20 (25%) with nystagmus, 4 (5%) with transient diplopia, and 4 (5%) with unpleasant emergence reactions. None of the patients required an airway intervention or had hypotension or vomiting. Ketofol provided adequate sedation and patient immobility in children undergoing biopsies. We observed hemodynamic stability, satisfactory postoperative recovery profiles, and no clinically significant complications. Our data suggest that ketofol is an effective sedative agent that provides a safe procedural sedation in children undergoing biopsies.

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Bu çalýþmada, yaygýn hasta sol ön inen arterin, koroner arter bypass cerrahisi sýrasýnda, safen ven patch ile rekonstrüksiyonu ve sol internal torasik arterin patch ile anastomuzunun cerrahi sonuçlarýný analiz ettik.
2009 ve 2014 yýllarý arasýnda 21 hastaya (ortalama yaþ 65.1 yýl) sol internal torasik arter bypass ile kombine edilen venöz patch anjioplastisi yöntemi uygulandý. Hastalarýn 5 inde (%24.8) geçirilmiþ miyokard enfarktüsü hikayesi vardý. Ýki hastada (%9,5) kararsýz angina ve 1 hastada (%4.8) akut anteroseptal miyokard enfarktüsü vardý. On iki hasta (%54.0) Kanada Kardiyovasküler Cemiyeti sýnýf III veya IV ve 10 hasta (%48.0) New York Kalp Birliði sýnýf III veya IV idi. Hasta baþýna yapýlan ortalama distal anastomoz sayýsý 3.24 ± 0.62 idi. Ortalama ven patch uzunluðu 4.14 ± 0.82 cm idi.
Otuz günlük mortalite oraný %4.8 (n=1) idi. Takiplerde, 2 si kardiyak kökenli olmak üzere sýrasýyla 2 inci ay, 11 inci ay ve 40 ýncý aylarda toplam 3 geç dönem ölüm oldu. Gerçek yaþam oraný 2 yýlda %90.0 ve 5 yýlda %81 idi. Kontrol anjiyografisi (15 hastada, %71.4) hastalarýn %93.3 ünde çalýþan sol internal torasik arter greftini ortaya koydu.
Sol ön inen arterin endarterektomi yapýlmadan, otolog safen ven patch ile uzun segment rekonstrüksiyonu, yaygýn hasta koroner arteri olan hastalarda kabul edilebilir uzun dönem sonuçlarýyla, alternatif bir yaklaþým saðlar.

In this study we analyzed the surgical outcomes of reconstruction of the diffusely diseased left anterior descending artery (LAD) with saphenous vein patch, completed by left internal thoracic artery (LITA) grafting on to the patch during on-pump coronary artery bypass surgery.
Between 2009 and 2014, 21 patients (mean age 65.1 years) underwent vein patch angioplasty combined with left internal thoracic artery bypass. Five of them (24.8%) had a history of old myocardial infarction, and 2 patients (9.5%) had unstable angina and 1 patient (4.8%) had acute anteroseptal myocardial infarction. Twelve patients (54.0%) were Canadian Cardiovascular Society class III or IV, and 10 patients (48.0%) were New York Heart Association class III or IV. The average of distal anastomoses per patient was 3.24 ± 0.62. The mean lenght of vein patch was 4.14 ± 0.82 cm.
The 30-day mortality rate was 4.8% (n=1). There were 3 late cardiac-related deaths at the 2 month, 11 month and 40 month follow-up, respectively. The actual survival was 90.0% at 2 years and 81.0% at five years. Follow-up angiogram (15 patients, 71.4%) revealed patent LITA graft in %93.3 of the patients.
Long segmental LAD reconstruction with autologous saphenous vein patch without endarterectomy, provides alternative approach to the patients who have diffusely diseased coronary arteries, with acceptable long-term results.

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Bu çalýþmada infertil çiftlerde, eþler arasý yaþ farkýnýn cinsel disfonksiyona (CD) etkisinin olup olmadýðýný araþtýrmayý amaçladýk. Ayrýca CD ile iliþkili olabilecek risk faktörlerini deðerlendirdik. Kesitsel ve ölçekli anket çalýþmamýza, infertilite polikliniðimize baþvuran 90 primer veya sekonder infertil hasta dahil edildi. Hastalarda CD’nin varlýðýný ve þiddetini belirlemek için Arizona Cinsel Deneyim Ölçeði (ACDÖ) kullanýldý. Risk faktörleri; yaþ, eþ yaþý, evlilik süresi, gebelik sayýsý, bazal hormon deðerleri, infertilite tipi ve etyolojisi, sigara, ek hastalýk, sosyoekonomik durum, eðitim düzeyi, evlilik þekli ile birlikte eþler arasý yaþ farký ve ACD skoru olarak kaydedildi. ACDÖ anketinin sonuçlarýna göre CD saptanan 23 (%25,6) kadýn ile saptanmayan 67(%74,4) kadýnýn klinik ve demografik özellikleri karþýlaþtýrýldý. 22 (%24,6) hastada düþük, 59 (%65,6) hastada orta ve 9(%10) hastada þiddetli düzeyde CD tespit edildi. Kadýnlarda yaþ 18-38, erkeklerde ise 21-45 arasýnda deðiþti. Sekonder infertilite CD grubunda daha yaygýndý (%47,8 vs %19,8; p: 0,008). Eþler arasýndaki yaþ farkýnýn (-3 ile 13 arasýnda deðiþen) CD olan grupta istatistiksel anlamlý düzeyde daha fazla olduðu belirlendi (5,5±2,3 vs. 3,0±2,7; p<0,001). Multivaryant lojistik regresyon analizi sonrasý eþler arasý yaþ farkýnýn 1,430 odds oraný (1,121-1,824, %95 güven aralýðý) ile en önemli baðýmsýz risk faktörü olduðu gösterildi. Bu çalýþmada infertil kadýnlarda CD’ye neden olan en önemli risk faktörünün evli çiftler arasýndaki yaþ farký olduðu bulunmuþtur. 5 yaþ farkýn CD’yi ayýrt etmede en anlamlý eþik deðeri olduðu hesaplanmýþtýr.

The objective of this study is to evaluate the relationship between sexual dysfunction (SD) and age difference among infertile couples. We also examined the possible risk factors associated with SD. A total of 90 primary or secondary infertile patients were included in this scaled cross sectional study. SD was determined with Arizona Sexual Experience (ASEX) scale. Risk factors recorded were; age, partner age, duration of marriage, number of pregnancies, basal hormone levels, types and etiology of infertility, smoking, comorbidities, socioeconomic status, education level, marital shape with the age difference between couples, ASEX score. The demographics and clinical characteristics of 23 (%25.6) infertile women with SD and those 67(%74.4) without SD were compared. 22 (% 24.6) patients had mild SD, 59 (% 65.6) patients had moderate, and 9 (% 10) patients had severe CD. The age of the women ranged between 18-38 years and it was ranged between 21-45 years in men. Secondary infertility were more common among SD group (%47.8 vs. %19.8; p=0.008). The age difference (ranged –3 and 13) between couples statically significantly differed between the two groups (5.5±2.3 vs. 3.0±2.7; p<0.001). Multivariate logistic regression model showed that age difference was an independent risk factor for SD with an odds ratio of 1.430 (1.121-1.824, 95% confidence interval). According to our results, the most important risk factors that cause SD among infertile couples were found to be age difference between couples. The significant threshold value was calculated as 5 years to distinguish women with SD.

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Bu retrospektif çalýþmanýn amacý, baþ dönmesi þikayeti ile baþvuran hastalarda eþlik eden semptomlarýn ve Baþ Dönmesi Engellilik Anketi sonuçlarýnýn deðerlendirilmesidir.
Çalýþmada, baþ dönmesi þikayeti ile baþvuran 400 hastanýn verileri deðerlendirilmiþtir. Semptomlar, vestibüler ve iþitme testlerinin sonucu ve Baþ Dönmesi Engellilik Anketi (BDEA) sonuçlarý kaydedilmiþtir. Vestibüler test bulgularýna göre hastalar 2 gruba ayrýlmýþtýr. Birinci gruba, pozitif vestibüler test bulgusu olan 241 hasta dahil edilmiþtir. Ýkinci gruba vestibüler test bulgularý normal elde edilen 159 hasta alýnmýþtýr. Dengesizlik, çýnlama, iþitme kaybý, kulakta dolgunluk, bulantý ya da kusma ve yüksek sesten rahatsýzlýk, sistemik hastalýk ve baþ aðrýsýnýn görüldüðü hasta sayýsý, gruplar arasýnda istatistiksel olarak anlamlý þekilde farklýlýk göstermiþtir (p<0.05). BDEA; emosyonel, fiziksel, fonksiyonel alt skorlarý ve total skorlarýnýn tümünde iki grup arasýnda istatistiksel olarak anlamlý fark elde edilmiþtir (p<0.05). Sonuç olarak; baþ dönmesi þikayeti ile baþvuran hastalarda; eþlik eden semptomlarýn ve BDEA ile baþ dönmesine baðlý engellilik düzeyinin saptanmasý,kapsamlý vestibüler deðerlendirme ve takip açýsýndan yol gösterici olabilir.

The aim of this retrospective study is to evaluate the accompanying symptoms and results of the Dizziness Handicap Inventory of patients presenting with complaint of vertigo. The data of 400 patients pesenting with complaint of vertigo were evaluated in this study. Symptoms, vestibular and hearing test results, Dizziness Handicap Inventory (DHI) results were recorded. The patients were divided into two groups according to the vestibular test results. The first group consisted of 241 patients who have positive vestibular test results. The second group consisted of 159 patients who have normal vestibular test results.
The number of patients with imbalance, tinnitus, hearing loss, aural fullness, nausea or vomiting, noises disturbance, headache and systemic diseases showed statistically significantly difference between two groups. The DHI emotional, functional, physical and total scores showed statistically significantly difference between two groups. As a result, associated symptoms and to determine the level of disability depends on the vertigo with BDEA may lead the way in terms of comprehensive vestibular assessment and follow up of patients presenting with complaint of vertigo

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Bu çalýþmanýn amacý Türk kadýnlarýnýn down sendromu tarama testleri hakkýndaki bilgi düzeyini, test sonuçlarýný deðelendirebilme becerilerini ve sonuçlar karþýsýndaki tutumlarýný deðerlendirmektir. Bu amaçla Türkiye genelinde 18 merkeze 600 anket gönderildi. Anketler gebe kadýnlara gebelik takibini yapan kiþiler tarafýndan uygulandý. Çalýþma sonuçlarýna gore hastalarýn ortalama doðru cevaplama oraný %21.6 bulundu [hasta bilgi düzeyini ölçen 6 soruda 1.3 (tablo 2)]. Sonuç olarak Türkiye’deki gebe kadýnlarýn çoðu down sendromu tarama testlerini duymuþ olsa da test içeriði ve test sonuçlarýný yorumlama hakkýnda yeterli bilgiye sahip deðillerdir.

Purpose of this study was to investigate the level of background knowledge about Down syndrome screening tests among women in Turkey, their ability to interpret the test results, and their attitudes in deciding how to proceed based on the results.
This study was performed by sending 600 questionnaires to 18 health centers throughout Turkey. The questionnaires were given to pregnant women by the practitioner following their pregnancy (including doctors and midwives).
The average correct answer rate of patients was found to be 1.3 out of every 6 questions (21.6%) [from the questions screening womens knowledge level (tablo 2)].
In conclusion most women in Turkey have heard about the screening tests for Down Syndrome, however they lack sufficient knowledge about the test content and the interpretation of the results.

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Amaç: Diyabetik makula ödemi (DMÖ) olan hastalarda yalnýz katarakt cerrahisi (FAKO) uygulamakla, FAKO ile ayný seansta intravitreal ranibizumab (ÝVR) uygulamanýn postoperatif sonuçlar üzerine etkisini karþýlaþtýrmak.
Metod: Kliniðimizde 2013-2015 yýllarýnda katarakt cerrahisi geçiren DMÖ tanýlý hastalarýn postoperatif görme keskinlikleri (Snellen)(GK) ve makula kalýnlýklarý (ortalama ve merkezi) (µ), preoperatif deðerleri ile ayný seansta FAKO’ ya ilaveten ranibizumab uygulanan DMÖ hastalarýnýn deðerleri ile kýyaslanmýþtýr.
Bulgular: Çalýþmaya 15 hastanýn 18 gözü katýlmýþtýr. Yalnýzca FAKO yapýlan grupta (Grup 1) preoperatif ortalama GK 0,27; postoperatif 1. ay ortalama GK 0,43; preoperatif ortalama merkezi makula kalýnlýðý 255µ; postoperatif merkezi makula kalýnlýðý 321µ idi. Ayný seansta FAKO ve ranibizumab yapýlan grupta (Grup 2) preoperatif GK 0,12; postoperatif 1. ayda ortalama GK 0,35; preoperatif ortalama merkezi makula kalýnlýðý 269µ; postoperatif 1. ayda ortalama merkezi makula kalýnlýðý 334µ idi. Grup 1’ de GK anlamlý deðiþim göstermezken Grup 2’ de anlamlý artýþ göstermiþtir.. Makula kalýnlýklarý açýsýndan iki grup arasýnda anlamlý fark bulunmamýþtýr.
Sonuç: Kataraktý olan DMÖ hastalarýnda, FAKO ile kombine ÝVR uygulamanýn sonuçlarý GK artýþý saðlamada sadece FAKO uygulamakla karþýlaþtýrýldýðýnda daha baþarýlýdýr.

Purpose: To compare the postoperative results of cataract surgery (FAKO) only vs FAKO combined with intravitreal ranibizumab (IVR) in the patients with diabetic macular edema (DME).
Methods: The preoperative and postoperative visual acuity (VA, Snellen) and macular thickness values of the patients with DME who had only FAKO surgery were compared with DME patients who had FAKO surgery combined with intravitreal ranibizumab (IVR).
Results: 18 eyes of 15 patients with DME and cataract were included in the study. The patients with FAKO surgery only (Group 1) had preoperative and postoperative first month VA of 0,27 and 0,43 respectively; the preoperative and mean central macular thickness (CMT) were 255µ and 321µ. The patients who had both FAKO surgery and IVR (Group 2) had preoperative and postoperative VA of 0,12 and 0,35; the pre and postoperative mean CMT were 269µ and 334µ respectively. While there was no statistically significant difference between the pre and postoperative VA of Group 1, the postoperative VA of Group 2 was significantly higher than the preoperative value. There was no difference between the pre and postoperative macular thickness values between those groups.
Conclusions: Cataract surgery combined with IVR results in a better VA improvement in patients with DME and cataract, compared with FAKO surgery only.

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Amaç: Otitis media komplikasyonlarý intrakranyal ve ekstrakranyal olarak sýnýflandýrýlýr ve genellikle progresif kemik erozyonlarýna, faysal sinirin, labirentin ve duranýn açýða çýkmasýna baðlýdýr. Antibiyotik öncesi dönemde akut ve kronik orta kulak enfeksiyonlarý ekstrakraniyal ve intrakraniyal infeksiyonlara sýklýkla neden olmaktaydý. Geliþmiþ antibiyotiklerin kullanýmýndan sonra otitis mediaya baðlý komplikasyonlar dramatik þekilde azalmýþtýr. Bu çalýþmanýn amacý hastalarýmýzda otitis media komplikasyonlarýný gözden geçirmek ve literatür ile karþýlaþtýrmaktýr.
Hastalar ve Yöntem: Çalýþmayý retrospektif olarak uyguladýk. 2013-2016 yýllarý arasýnda otitis mediaya baðlý temporal kemik erozyonu ve komplikasyonu geliþen hastalar incelendi.
Bulgular: Otitis mediaya baðlý komplikasyonu olan 26 hasta deðerlendirmeye alýndý. Bunlarýn 5’i (%19,23) intrakraniyal olup; beyin absesi (1), lateral sinüs trombozu (2), otitik hidrosefali (1) ve menenjit (1) en sýk görülen intrakraniyal komplikasyonlardý. Ekstrakraniyal komplikasyonlar 21 hastada (%80,76) mevcut olup; subperiostal abse (6), labirent fistülü (7), fasiyal paralizi (8) en sýk görülen ekstrakraniyal komplikasyonlardý. Tüm hastalara antibiyotik tedavisi ve uygun cerrahi tedavi prosedür uygulandý. Radikal mastoidektomi kolesteatomu olan ve intrakraniyal komplikasyon geliþen hastalara uygulandý ve gereðinde geniþletildi.
Sonuç: Kulak burun boðaz ve beyin cerrahisi tarafýndan erken taný, agresif antibiyotik tedavisi ve kombine yönetim, otitis media komplikasyonlarýna baðlý mortalite ve morbiditenin azalmasýnda kilit rol oynamaktadýr.

Objectives: Complications from otitis media are classified as extracranial or intracranial and are usually caused by progressive bony erosion, exposing the facial nerve, labyrinth and dura. In the preantibiotic era, acute and chronic middle ear infections frequently led to both extracranial and intracranial complications. The complications rate of otitis media have dramatically decreased since the advent of antibiotics. The aim of this study was to review our patients with complications of otitis media and compare with literature.

Patients and Methods: We performed a retrospective study. Patients who developed temporal bone erosion and complications because otitis media between the years 2013 and 2016 were investigated.

Results: There were 26 patients with complications of otitis media, which 5 [19,23%] were intracranial; brain abscess (1), lateral sinus thrombosis (2), otitic hydrocephalis (1) and meningitis (1) were the most common intracranial complications. Extracranial complications were present in 21 [80,76%] of the patients; subperiostal abscess (6), labyrinthine fistula (7), facial paralysis (8) were the most common extracranial complications. Antibiotic therapy and initial surgical treatment procedure were applied in all patients. Radical mastoidectomy was performed in ears with cholesteatoma and in cases of intracranial complications the operation was extended with appropriate interventions if required.

Conclussion: Early diagnosis, aggressive antibiotic therapy and combined management of cases by otologists and neurosurgeons are the key to reducing the morbidity and mortality of the serious complications of otitis media.

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Amaç: Sistemik Lupus Eritematozus (SLE) multisistemik ve otoimmün inflamatuvar bir hastalýktýr. Geleneksek kardiyovasküler (KV) risk faktörleri SLE’ li hastalarda normal populasyona göre daha sýktýr. Ancak geleneksek KV risk faktörlerini hesaplayan risk skorlamalarý SLE’ li hastalardaki gerçek kardiyovasküler riski olduðundan daha düþük göstermektedir. Bu nedenle karotis intima media kalýnlýðý (KÝMK) ve yüksek duyarlýklý C reaktif protein (yd-CRP) gibi aterosklerotik prediktörler, SLE’ lu hastalardaki gerçek KV riski deðerlendirmek için bu grup hastalarda araþtýrýlmýþtýr. SLE’ lu hastalarda KÝMK ve yd-CRP deðerlerinde artýþ saptanmýþtýr. Epikardiyal yað dokusu da koroner arter hastalýðýnýn oluþumunu ve geliþimini kuvvetli bir þeklide etkilemektedir.Ancak, SLE’ lu hastalarda epikardiyal yað kalýnlýðýnýn (EYK) normal popülasyona göre karþýlaþtýrýlmasý ile ilgili sýnýrlý veri mevcuttur. Bu nedenle bu çalýþma SLE’ lu hastalarda artmýþ KÝMK ve yd-CRP düzeyleri ile birlikte EYK’ da normal popülasyona göre artýþ olup olmadýðýný araþtýrmak için tasarlanmýþtýr. Gereç ve Yöntem: 38 ardýþýk SLE hastasý ve 34 saðlýklý gönüllü çalýþmaya dahil edilmiþtir. KÝMK ölçümleri lineer bir transdüserle, ultrasonografik olarak karotis arterlerden yapýlmýþtýr. EYK ölçümü için transtorasik ekokardiyografi cihazý kullanýlmýþtýr. Bulgular: SLE’ lu hastalarýn EYK ölçümleri saðlýklý gönüllülere göre anlamlý derecede yüksek bulundu ((4.5 ± 1.1 vs. 3.9 ± 0.9, p= 0.01). EYK ölçümleri ile SELENEA-SLEDAI indeksi, KÝMK ve yd-CRP deðerleri arasýnda direk korelasyonlar tespit edildi. Sonuç: Ekokardiyografik EYK ölçümü KÝMK ve yd-CRP deðerleri ile birlikte SLE' lu hastalarda gerçek kardiyovasküler risk deðerlendirmesinde tekrarlanabilir ve kolay bir yöntem olarak kullanýlabilir.

Objective: Systemic lupus erythematosus (SLE) is a multisystemic autoimmune inflammatory disease. Traditional cardiovascular (CV) risk factors are more prevalent in SLE patients than in the general population. Risk scores which take into account traditional risk factors for CV diseases underestimate true CV risk in SLE. Therefore, atherosclerosis risk predictors including carotid intima-media thickness (c-IMT), high-sensitivity C-reactive protein (hs-CRP) have been investigated in SLE to show true CV risk. Increased c-IMT and hs-CRP levels in SLE patients have been reported. Epicardial fat also strongly influences the formation and the progress of coronary artery disease. However, there is limited data comparing the epicardial fat thickness (EFT) of SLE patients with that of the normal population. This study was designed with the aim of further evaluating whether SLE patients have greater EFT values with increased c-IMT and hs-CRP levels when compared with a healthy group. Material and Methods: The population of this study was comprised of 38 consecutive SLE patients and 34 healthy volunteers. C-IMT was measured through ultrasonographic imaging of the common carotid arteries using a linear array transducer. Transthoracic echocardiography was used to measure EFT. Results: SLE patients had significantly higher EFT values than those of healthy volunteers (4.5 ± 1.1 vs. 3.9 ± 0.9, p= 0.01). There were also direct correlations between EFT values and SELENA– SLEDAI index, c-IMT and hs-CRP of study population. Conclusion: The echocardiographic EFT measurement can be used as a reproducible and practical tool for evaluation of cardiovascular risk with c-IMT and hs-CRP in SLE patients.

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Maskeli hipertansiyon (MH) ofis kan basýncý deðerleri normal (sistolik <140 mmHg, diastolik <90 mmHg ) iken, 24 saat ambulatuar kan basýncý ölçümlerinin yüksek (sistolik > 140 mm Hg, diastolik >90 mmHg) tespit edildiði klinik durum olarak tanýmlanýr. Son zamanlarda yapýlan gözlemsel çalýþmalarda maskeli hipertansiyon sýklýðýnýn %10-40 arasýnda olduðu rapor edilmiþtir. Hastalýðýn temel mekanizmasý henüz tam açýklanamamýþtýr. Ancak maskeli hipertansiyonun sigara içimi, aþýrý alkol tüketimi ve obezite ile iliþkili olabileceði düþünülmektedir. Uç organ hasarý sýklýðý ve kardiyovaskuler riskteki artýþ esansiyel hipertansiyonla benzer olarak izlenmektedir. Bu sebeplerden dolayý kýlavuzlar kötü kardiyovaskuler sonuçlarýn önlenmesi için maskeli hipertansiyon hastalarýna medikal tedavi önermektedir.

Masked hypertension is defined as a clinical condition in which patients have normal office blood pressure values while having high ambulatory blood pressure measurements. The prevalance of masked hypertension is reported as 10-40 % in recent registries. Although the main mechanism of that disease has not been well-defined yet. However ýt may be associated with smoking, alcohol abuse and obesity. The increment in the incidence of endorgan damage and cardiovascular disease risk in patient with masked hypertension is similar to essential hypertension. Therefore the guidelines suggest medical treatment for patient with masked hypertension to prevent worse cardiovascular outcome.

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Yaþa Baðlý Makula Dejenerasyonu 65 yaþ üzeri kiþilerde geri dönüþümsüz görme kaybýnýn önde gelen sebeplerinden birisidir. Santral görme kaybýyla sonuçlanan makulanýn ilerleyici dejeneratif bozukluðu hastalýktaki ana problemdir. Hastalýðýn atrofik ve eksudatif olmak üzere iki formu vardýr. Nüfusun yaþlanmasý Yaþa Baðlý Makula Dejenerasyonu prevelansýný arttýrýr ve sosyal ve ekonomik sýkýntýlara neden olur. Yaþa Baðlý Makula Dejenerasyonu açýsýndan riskli hastalarýn yönetimiyle ilgili birçok çalýþma yapýlmýþ ve yeni tedaviler geliþtirilmeye çalýþýlmýþtýr. Bu derlemede, Yaþa Baðlý Makula Dejenerasyonun þu anki ve gelecekteki tedavi seçenekleri tartýþýlmýþtýr.

Age-Related Macular Degeneration is the leading cause of irreversible blindness over 65 years of age. Progressive degenerative disorder of the macula resulting in a loss of the central vision is the main problem in the disease. There are two forms of Age-Related Macular Degeneration, the atrophic and the exudative form. Ageing of the population may increase the prevalence of Age-Related macular degeneration and cause social and economical burden. Much research has been done to manage the people at risk of Age-Related macular degeneration and to develop new treatments. In this review, we will discuss the current and future therapeutic options of Age-Related Macular Degeneration.

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GÝRÝÞ:
Geliþimsel kalça displazisinin etiyolojisinde belli baþlý faktörler olmakla birlikte septik artritin de kalça yarý-çýkýðýna (subluksasyon) ve geliþimsel kalça displazisine neden olduðu bilinmektedir.
OLGU SUNUMU:
Bu olgu sunumunda, üçüz eþi ve prematür olarak dünyaya gelen bir olguda Candida spp.'nin etken olarak tespit edildiði yenidoðan kalça septik artritinden sonraki klinik ve ultrasonografik kontrolleri normal olmasýna karþýn ileriki takiplerinde etkilenen kalçasýnda yarý-çýkýk geliþen hasta sunulmaktadýr.
SONUÇ:
Kalça septik artritinin nadir bir yarý-çýkýk sebebi olduðu ortaya konarak özellikle öyküsünde kalça septik artriti bulunan hastalarýn yakýn takip edilmesi ve topallama þikayetlerinin önemsenmesi gerektiði vurgulanmaktadýr.

INTRODUCTION:
Although there is major contributing factors causing developmental hip dysplasia, it is a well known fact that septic arthritis may cause hip dysplasia.
CASE REPORT:
In this case report, a 28-day-old female patient whose ultrasonographic findings were found to be normal during newborn period after septic arthritis of the hip, and who later developed hip subluxation is presented. The treatment of the patient is achieved with acetabular coverage through pelvic osteotomy.
CONCLUSION:
It is emphasized that hip dysplasia, which is one of the rare complications of the septic arthritis, should be taken into consideration especially in patients with complaints of limping and yet the importance of close follow up of patients with a history of septic arthritis for the risk of hip dysplasia and subluxation.

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Lipomlar sýk görülen tümörler olmalarýna raðmen vulvada sýk deðildirler. Vulvar lipom saptanan olgumuz, lipomun eksizyonundan 3 ay önce normal doðum yapmýþ, 37 yaþýnda tiroid kanseri bir hastadýr. Olgumuzda yavaþ geliþen vulvar kitle sunuldu. Hastanýn yakýnmasý kitlenin “testis gibi” görünmesi idi. Hastamýzda papiller tiroid kanseri öyküsü mevcuttu ve ikinci operasyonundan sonra radyoaktif iyot tedavisi almýþtý. Bununla birlikte hastamýz 3 ay önce vaginal doðum gerçekleþtirebildi. Fizik muayenede hastanýn sol labium majöründe 3x5 cm (santimetre) boyutlarýnda aðrýsýz kitle saptandý (Þekil 1). Kitle genel anestezi altýnda tamamen çýkarýldý (Þekil 2). Histolojik incelemede matür adipositlerden oluþan vulvar lipomu iþaret eden benign tümör saptandý. Lipomlar çoðunlukla kolay farkedilen, aðrýsýz yumuþak kitlelerdir. Travma, altta yatan en sýk sebep olmasýna raðmen bizim vakamýz travma deðil papiller tiroid kanseri öyküsüne sahiptir. Malignite olasýlýðýna karþýlýk vulvar lipomlarýn total olarak çýkarýlmasý daha güvenlidir. Bu olgumuzla çoðunlukla Bartholin kisti olarak yanlýþ taný alan bu benign tümörün atipik yerleþim yerine dikkat çekmek istedik.

Lipomas are frequently seen tumors but not often on vulva. In our case it was diagnosed in a 37 year old thyroid cancer patient who gave vaginal birth three months before the excision of the lipoma. We report the case of a vulvar mass that progressed slowly. The complaint of our patient was the ‘testis like’ appearance of the mass. She had the history of papillary thyroid cancer who underwent radioactive iodine therapy after her second operation. Nevertheless she even succeeded in vaginal delivery three months before. Physical examination showed a non-tender mass in her left labium majus that measured 3x5 centimetres (cm) (Figure 1). The mass was completely excised under general anaesthesia (Figure 2). The histologic examination showed a benign tumor composed of mature adipocytes, indicating vulvar lipoma. Lipomas are mostly painless soft tumors which can be recognized easily. Although trauma is the most common underlying reason, our case was with the history of papillary thyroid cancer not trauma. It is safer to excise vulvar lipomas totally to eliminate the possibility of malignancy. We intented to take attention to this atypical localization of this benign tumor which may be most often misdiagnosed as Bartholin cyst.

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Koanal polipler herhangi bir sinüsten kaynaklanan ve nazofarenkse uzaným gösterebilen izole kitleler olup bu patolojilerin çoðu maksiller sinüs kaynaklý antrokoanal poliplerdir. Ýntranazal anatomik varyasyonlarýn olmasý antrokoanal polip cerrahisini zorlaþtýrabilmektedir. 40 yaþýnda erkek hasta polikliniðimize sað göz çevresinde aðrý ve sað taraflý burun týkanýklýðý þikayetleri ile baþvurdu

Choanal poyps are isolated masses originating from any sinus and extending to nasopharynx and most of them are antrochoanal polyps arising from maxillary sinus. Presence of intranasal anatomical variations can make surgery of antrochoanal polyps difficult. A 40 years-old male presented to our clinic with right periorbital pain and right-sided nasal obstruction.

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Elli bir yaþýnda,erkek hasta, eforla iliþkili nefes darlýðý ve 3 aydýr devam eden kuru öksürük þikayeti ile kliniðimize baþvurdu. Hikayesinde EKG' de Q dalgalarý ile kendini gösteren sessiz bir inferior miyokard enfarktüsü mevcuttu. Hasta öncesinde þikayet tarif etmiyordu. Ýki boyutlu transtorasik ekokardiyografide, sol ventrikül infero-bazal segmente komþu, dar boyunlu ve doppler incelemesinde ileri-geri akým sinyali veren ikinci bir kalp odacýðý (6 cm x 5 cm) saptandý. Ventrikülografi, yaklaþýk 6x5 cm çapýnda, sol ventrikül inferior duvarýnda, kum saatine benzeyen bir psödoanevrizmayý gösterdi. Koroner anjiyografide, sirkumfleks koroner arterin tam týkalý olduðu üç damar hastalýðý saptandý. Bu bulgular, eski bir inferior miyokard enfarktüsü sonucunda geliþen sol ventrikül psödoanevrizmasý ile uyumlu idi. Sol ventrikül psödoanevrizmasý ve eþlik eden koroner arter hastalýðý tanýsý konduktan sonra hastaya ameliyat önerildi. Hastaya yalancý anevrizma onarýmý da dahil olmak üzere koroner arter bypass ameliyatý uygulandý. Ancak, ne yazýk ki hasta intraoperatif kaybedildi Bu vaka, psödoanevrizmanýn, semptomsuz seyreden sessiz miyokard enfarktüsü sonrasý geliþebileceðini göstermektedir. Ayrýca, psödoanevrizmanýn akciðerler gibi komþu organlara invazyon göstermesi cerrahi mortalite riskini arttýrmaktadýr.

A 51-year-old man was referred to our institution for dyspnea on exertion and non-productive cough, of three-month history. His clinical history was characterized by a silent inferior myocardial infarction detected by an ECG that presented inferior Q waves. He had not previously presented symptoms. Two-dimensional transthoracic echocardiography demonstrated a second large cardiac chamber (6 x 5 cm) adjacent to the inferior-basal left ventricle wall, with a narrow neck and to-and-from signals at doppler evaluation. Ventriculography showed a pseudoaneurysm, like an hourglass, on the inferior wall of the left ventricle which is approximately 6 x 5 cm in diameters. Coronary angiography showed triple vessel disease with total occlusion of the circumflex coronary artery. These findings were consistent with left ventricular pseudoaneurysm resulting from an old inferior myocardial infarction. After diagnosis of left ventricular pseudoaneurysm and concomitant coronary artery disease, surgery was recommended. He underwent coronary artery bypass surgery including the repair of the pseudoaneurysm. But, unfortunately the patient died in during the operation. This case illustrates that pseudoaneurysm could develop after silent myocardial infarction with non-specific symptoms. In addition, if false aneurysm invades adjacent organs such as lungs, increases the risk of surgical mortality.

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